Case Manager RN

Aetna Inc. Birmingham , AL 35202

Posted 6 days ago

Job Description

This Case Manager RN position is 100% remote and the employee can live in any state.

Normal Working Hours: 8:00am through 4:30pm EST with a 10:30am-7:00pm EST rotation several times per Quarter.

Rotational coverage of evenings, weekends and holidays will be per the needs of the department.

No travel is expected with this position.

The Case Manager RN utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.

The Case Manager RN process includes assessing the member's health status and care coordination needs, inpatient review, and discharge planning, developing, and implementing the case management plan, monitoring, and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria.

The Case Manager RN role requires a nurse that can exercise independent and sound judgment and someone that has strong decision-making skills and well-developed interpersonal skills. The Case Manager RN is expected to manage multiple priorities, demonstrate both effective organizational and time management skills as well demonstrate strong teamwork skills.

The responsibilities of this Case Manager RN position are to:

  • Apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs.

  • Conduct comprehensive clinical assessments.

  • Evaluate needs and develop flexible approaches based on member needs, benefit plans or external programs/services.

  • Advocate for patients to the full extent of existing health care coverage.

  • Promote quality, cost effective outcomes, and make suggestions to improve program/operational efficiency.

  • Identify and escalate quality of care issues through established channels.

  • Provide an expected very high level of customer service.

  • Utilize assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change.

  • Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.

  • Provide coaching, information, education, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices

Pay Range

The typical pay range for this role is:

Minimum: 55,300

Maximum: 118,900

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications

  • An RN that must hold an unrestricted license in their state of residence and have the ability to obtain multi-state licensure upon hire
  • 5+ years of acute care experience as an RN required
  • 3+ years of experience with Microsoft Suite of products

Preferred Qualifications

  • Compact RN License

  • Certified Case Manager (CCM)

  • Managed Care experience

  • Home Care experience

  • Telephonic case management and/or telephonic customer service center experience

Education

Associate Degree with RN licensure required; BSN preferred.

Business Overview

Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.


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